Alptekin Gursoy - Academia.edu (original) (raw)

Papers by Alptekin Gursoy

Research paper thumbnail of SSuubbcclliinniiccaall HHyyppootthhyyrrooiiddiissmm iiss nnoott AAssssoocciiaatteedd wwiitthh H Hyyppeerrhhoommooccyysstteeiinnyyeemmiiaa Subklinik Hipotiroidi Hiperhomosisteinemi ile ‹liflkili Deildir

Objective: There are controversial reports regarding subclinical hypothyroidism and its associati... more Objective: There are controversial reports regarding subclinical hypothyroidism and its association with hyperhomocysteinyemia. We aimed to evaluate whether subclinical hypothyroidism is associated with hyperhomocysteinyemia and sought to explain the observed increased risk of coronary artery disease in patients with subclinical hypothyroidism. Materials and Methods: Seventy patients (56 women, 14 men; mean age, 57.0±12.4 years) with subclinical hypothyroidism and 124 euthyroid

Research paper thumbnail of CCoommppaarriissoonn ooff tthhee AAnnaallggeessiicc EEffffiiccaaccyy ooff LLiiddooccaaiinnee//PPrriillooccaaiinnee ((EEMMLLAA)) CCrreeaamm aanndd NNeeeeddllee--FFrreeee DDeelliivveerryy o off LLiiddooccaaiinnee DDu urriinngg F Fiinnee--NNeeeeddllee AAssppiirraattiioonn BBiiooppssyy ooff TThhyyrro...

Objective: Efficacy of eutectic mixture of local anesthetic (EMLA) cream and the needle-free inje... more Objective: Efficacy of eutectic mixture of local anesthetic (EMLA) cream and the needle-free injection of local anesthesia for reducing pain associated with fine-needle aspiration biopsy (FNAB) of thyroid nodules has been previously reported. However, there has not been a direct com- parison of the analgesic efficacy of these methods. The aim of this study was to compare the analgesic efficacy

Research paper thumbnail of Changes in Insulin Sensitivity and Glucose and Bone Metabolism over Time in Patients with Asymptomatic Primary Hyperparathyroidism

Objective: The clinical profile of asymptomatic primary hyperpara- thyroidism (PHPT) has shifted ... more Objective: The clinical profile of asymptomatic primary hyperpara- thyroidism (PHPT) has shifted from a symptomatic disorder toward a more subtle, asymptomatic state. The lack of knowledge about the natural course of asymptomatic PHPT contributes to the controversy regarding the optimal management of these patients. The aim of this study is to evaluate the natural course of calcium and glucose me-

Research paper thumbnail of Fine needle aspiration biopsy of a thyroid nodule: A comparison of diagnostic performance of experienced and inexperienced physicians

Endocrine Practice, 2010

ABSTRACT To determine whether a difference exists in terms of obtaining adequate cytologic sample... more ABSTRACT To determine whether a difference exists in terms of obtaining adequate cytologic samples from ultrasound-guided fine-needle aspiration cytology (US-FNAC) between experienced and inexperienced physicians in a tertiary referral center. In a prospective design, all patients with thyroid nodules of at least 10 mm in diameter were referred for US-FNAC tissue sampling as a part of their diagnostic work-up. Between May 2006 and September 2009, 997 euthyroid patients with 1,320 thyroid nodules were referred for US-FNAC by the attending endocrinologist (experienced physician) or 1 of 2 endocrinology fellows (inexperienced physicians). Of the 1,320 nodules, 713 biopsy specimens were obtained by the experienced physician and 607 were obtained by the inexperienced physicians. Nodule size was significantly larger in the endocrinologist's group of patients than in the fellows' group of patients (17 mm versus 14 mm, respectively; P<.001). The inadequacy rate of the US-FNAC procedures performed by the experienced physician (22 of 713 thyroid nodules or 3.1%) was significantly lower than for those performed by the inexperienced physicians (102 of 607 thyroid nodules or 16.8%) (P<.001). We conclude that, with increasing operator experience, the number of inadequate cytologic specimens generated by US-FNAC procedures is substantially reduced. This limits both direct and indirect costs and also minimizes the risks of possibly unnecessary surgical procedures.

Research paper thumbnail of Thyroid volume in patients with glucose metabolism disorders

Arquivos brasileiros de endocrinologia e metabologia, 2014

Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistan... more Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistance. A relationship between thyroid volume and glucose metabolism disorders (GMD) has not as yet been clarified. The present retrospective study aimed to investigate the association between GMD and thyroid volume. We investigated the data of 2,630 patients who were evaluated for thyroid biopsy in our hospital. The study population included 602 patients with GMD, 554 patients with diabetes mellitus (DM) and 1,474 patients with normal glucose metabolism as a control group. We obtained the levels of serum thyroid stimulating hormone (TSH) and the thyroid volumes of those patients retrospectively. The median ages for the control group, GMD group and DM group were 55 (15-91) years, 60 (27-97) years, and 65 (27-91) years respectively and there was a statistically significant difference between the groups with regard to age and gender (p<0.001). Levels of TSH were similar in all groups. The m...

Research paper thumbnail of Clinical and epidemiological characteristics of thyroid hemiagenesis: ultrasound screening in patients with thyroid disease and normal population

Endocrine, 2008

Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to dev... more Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to develop. The true prevalence of this rare abnormality is about 0.05-0.2% in normal population. We aimed to determine prevalence of thyroid hemiagenesis in patients with various thyroid disorders and a normal population in a mild to moderate iodine-deficient area. The clinical and thyroid ultrasonography records of 4,833 patients who presented with various thyroid disorders were reviewed. In addition, ultrasonographic data of two large surveys carried out for the community screening of iodine status of children (n = 4,772) and thyroid disorders of adult subjects (n = 2,935) were analyzed. In patients with thyroid disorders, we found 12 cases with thyroid hemiagenesis (0.25%). Thyroid hemiagenesis was due to the agenesis of the left lobe in all cases. The underlying thyroid diseases were Hashimoto's thyroiditis (n = 4), euthyroid multinodular goiter (n = 4), and toxic adenoma (n = 1). Thr...

Research paper thumbnail of Isolated office hypertension: association with target organ damage and cardiovascular risk indices

Journal of the National Medical Association, 2006

Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, w... more Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, whereas others believe that it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this present study was to evaluate the effects of IOH on target organ damage and cardiovascular risk indices. Arterial blood pressure (BP) measured in the office and by 24-hour ambulatory blood pressure measurement (ABMP), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), cardiothoracic index (CTI), duration of QTc, 24-hour microalbuminuria, fibrinogen, C-reactive protein (CRP), total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels were evaluated. Thirty-three subjects with IOH (office BP > or = 140/90 mmHg and daytime ambulatory BP <135/85 mmHg), 17 patients with sustained hypertension (office BP > or = 140/90 mmHg and daytime ambulatory BP > or = 135/85 ...

Research paper thumbnail of Effect of sibutramine on blood pressure in patients with obesity and well-controlled hypertension or normotension

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

To assess the short-term effects of sibu-tramine on blood pressure (BP) and heart rate (HR) in no... more To assess the short-term effects of sibu-tramine on blood pressure (BP) and heart rate (HR) in normotensive and controlled hypertensive obese patients by using ambulatory blood pressure monitoring (ABPM). Before and 5 to 7 days after the initiation of sibutramine treatment (10 mg or 15 mg daily), when steady-state concentrations of sibutramine had been reached, ABPM was performed in 81 obese patients. Of this overall study group, 47 patients (26 with normoten-sion and 21 with controlled hypertension) received sibu-tramine in a dosage of 10 mg/day, and 34 patients (18 with normotension and 16 with controlled hypertension) received sibutramine in a dosage of 15 mg/day. Office-measured systolic and diastolic BPs in normotensive and controlled hypertensive groups of patients with obesity were not significantly different before and after treatment with both doses of sibutramine. ABPM results for normotensive obese groups showed that mean systolic and diastolic BPs were not significantly ...

Research paper thumbnail of Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle (Urtica dioica )

Nettle (Urtica dioica ) is commonly sold as a herbal tea in Turkey. We report a case of gynaecoma... more Nettle (Urtica dioica ) is commonly sold as a herbal tea in Turkey. We report a case of gynaecomastia in a man (in which the only aetiologic factor identified was nettle tea consumption) and a case of galactorrhoea in a woman (in which the only aetiologic factor identified was also nettle tea ingestion). The term gynaecomastia describes the enlargement of

Research paper thumbnail of New-Onset Acute Heart Failure After Intravenous Glucocorticoid Pulse Therapy in a Patient with Graves' Ophthalmopathy

Endocrine, 2006

A 53-yr-old previously healthy man was admitted to our hospital for thyrotoxicosis without ophtha... more A 53-yr-old previously healthy man was admitted to our hospital for thyrotoxicosis without ophthalmopathy. Initial therapy with propylthiouracil caused an acute elevation of liver enzymes. Then, he received a first course of 131I therapy (20 mCi). At the end of 6-mo follow-up after 131I, he was still thyrotoxic and developed moderately severe ophthalmopathy. The patient refused thyroid surgery and decided to undergo second course of 131I therapy (30 mCi). Concomitantly with the 131I, we opted to give high-dose pulse glucocorticoid therapy (PGT) to prevent further deterioration of GO. The patient was started on intravenous methylprednisolone pulse therapy 1 g daily in a cycle (one cycle every 2 wk, each cycle comprising two infusions on alternate days). After the end of the second day of PGT administration, he suddenly developed onset of acute pulmonary edema and hypertension. There was no previous history of cardiac disorder or conditions predisposing to cardiac failure other than thyrotoxicosis. A presumptive diagnosis of fluid overload and/or hypertension- induced acute heart failure was made. After prompt investigations excluding cardiogenic causes, we thought that this condition was triggered by PGT that was superimposed on thyrotoxicosis-related hemodynamic instability. Graves&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; patients with uncontrolled thyrotoxicosis should be under careful surveillance when PGT is planned. To our knowledge, this is the first reported case of life-threatening acute pulmonary edema caused by PGT in GO.

Research paper thumbnail of Postprandial Lipemia as a Risk Factor for Cardiovascular Disease in Patients with Hypothyroidism

Endocrine, 2006

Postprandial lipoprotein metabolism is suggested to play a role in the pathogenesis of atheroscle... more Postprandial lipoprotein metabolism is suggested to play a role in the pathogenesis of atherosclerosis. In this study, we investigated postprandial lipemia and its relationship to cardiovascular risk factors in patients with overt and subclinical hypothyroidism. Twenty-nine female patients with TSH levels greater than 5 microIU/mL and 12 euthyroid control female subjects were included in the study. Fifteen patients had subclinical hypothyroidism and 14 had overt hypothyroidism. All subjects underwent an oral lipid tolerance test. If triglyceride levels increased by 80% or more, subjects were considered postprandial lipemia positive. Control, overt hypothyroid, and subclinical hypothyroid groups were not statistically different with respect to anthropometric measurements, fasting blood C-reactive protein, uric acid, homocysteine, glucose, insulin, lipoprotein (a), apolipoprotein B levels, and homeostasis model assessment index. Fasting triglyceride levels correlated positively with TSH levels. Postprandial lipemia frequency was higher in overt hypothyroid subjects than in the control group. The subclinical hypothyroid group did not differ from the hypothyroid group with respect to postprandial lipemia frequency. In subjects with TSH levels higher than 5 microIU/mL, PPL risk was increased sevenfold. The results of this study show that postprandial triglyceride metabolism is affected in hypothyroidism.

Research paper thumbnail of Hashimoto's Thyroiditis Is Not Associated with Increased Risk of Thyroid Cancer in Patients with Thyroid Nodules: A Single-Center Prospective Study

Thyroid, 2010

The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto&amp;... more The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto&amp;amp;amp;amp;#39;s thyroiditis (HT) is a debatable issue. The studies defining the true risk of thyroid malignancy are scanty and mainly depend on retrospective series. To eliminate inherent bias of retrospective studies, this prospective study was carried out to evaluate the true malignancy rate of unselected thyroid nodules in patients with HT who underwent fine-needle aspiration cytology (FNAC). These prospective data were gathered on all patients newly diagnosed with thyroid nodules who were sent for FNAC between May 2006 and August 2009. All patients were evaluated for the presence of HT diagnosis by measuring thyroid autoantibodies. If a patient had at least one positive thyroid autoantibody, then the patient was defined as HT with thyroid nodules. There were 164 patients (147 women and 17 men) with thyroid nodules associated with HT (HT group). There were 551 patients (432 women and 119 men) with thyroid nodules without HT (control group). All patients underwent FNAC and ultrasonography (US). The malignancy rate was 1.0% in HT group (2 out of 191 nodules) and 2.7% in the control group (19 out of 713 nodules), a not significant (p = 0.19) difference. In the two cytologically malignant nodules in HT group and 19 in the control group, papillary thyroid carcinoma was diagnosed after thyroidectomy and histopathological examination. US features of nodule echogenicity, structure, margin, and Doppler flow were similar between the two groups. US features of microcalcification and absence of peripheral halo were more prominent in the nodules of the control group (p = 0.002 and p &amp;amp;amp;amp;lt; 0.001, respectively). On the basis of cytopathological criteria, thyroid nodules in patients with HT are no more likely to be malignant than in those without HT. Many of the US features of benign thyroid nodules are similar in patients with and patients without HT.

Research paper thumbnail of Subclinical Cushing Syndrome Presenting With Hypertension and Hypokalemia

The Endocrinologist, 2007

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Th... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Endocrinologist. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is ...

Research paper thumbnail of Rosiglitazone Decreases Serum Bone-Specific Alkaline Phosphatase Activity in Postmenopausal Diabetic Women

Results: Serum total alkaline phosphatase (ALP) and bone-specific ALP levels were statistically s... more Results: Serum total alkaline phosphatase (ALP) and bone-specific ALP levels were statistically significantly lower 12 wk after initiation of rosiglitazone treatment. There were no statistically significant changes in osteocalcin levels among the three groups or in deoxypyr- idinoline levels in the rosiglitazone group. At the end of 12 wk, all patients had statistically significantly decreased IL-1 and TNF- levels compared

Research paper thumbnail of Mean platelet volume in patients with polycystic ovary disease

Platelets, 2006

1. Platelets. 2006 Nov;17(7):505-6. Mean platelet volume in patients with polycystic ovary diseas... more 1. Platelets. 2006 Nov;17(7):505-6. Mean platelet volume in patients with polycystic ovary disease. Gursoy A, Ertugrul DT, Pamuk B, Sahin M, Asik M, Yilmaz H, Haydardedeoglu F, Tutuncu NB, Demirag NG. PMID: 17074730 [PubMed - indexed for MEDLINE]. ...

Research paper thumbnail of Comparison of Palpation-Guided Fine-Needle Aspiration Biopsy to Ultrasound-Guided Fine-Needle Aspiration Biopsy in the Evaluation of Thyroid Nodules

Thyroid, 2006

Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method,... more Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this prospective study, we compared palpation-guided FNAB (PGFNAB) with ultrasound-guided FNAB (UGFNAB) to establish the rates of inadequate material and cost-effectiveness. A total of 285 thyroid nodules in 215 patients were included in the study. Palpable nodules with the greatest diameter between 1 and 2.5 cm were included in the study. PGFNAB and UGFNAB techniques were applied to the same nodule by the same operator. Cytologic evaluations were performed by the same cytologist in a blinded fashion. To provide cost analysis, the prices obtained from different hospitals were evaluated. The rates of inadequate material for PGFNAB and UGFNAB were significantly different as 32.3% and 21.4%, respectively (p = 0.004). There was significantly higher inadequate material rate in PGFNAB group for small-sized nodules (greatest nodule diameter between 10 and 15 mm) (p = 0.009), despite inadequate material rate was not significant for both procedures for larger sized nodules. False-negative results were 15.8% for PGFNAB and 5.6% for UGFNAB. Regarding cost analysis, the difference between the two methods was 20 dollars on average for each patient. We consider UGFNAB to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation. Indeed, the difference between the costs of two procedures might be acceptable.

Research paper thumbnail of Clinicopathological Characteristics of Thyroid Cancer in Patients on Dialysis for End-Stage Renal Disease

Thyroid, 2008

The prevalence rate of thyroid cancers in patients with renal failure is variable in different st... more The prevalence rate of thyroid cancers in patients with renal failure is variable in different studies. Our aim was to determine the prevalence and clinicopathological characteristics of thyroid cancers in the dialysis population and to evaluate the potential risk factors. We performed a retrospective analysis on end-stage renal disease (ESRD) patients on dialysis and thyroidectomized patients without ESRD (2000-2006). Then we compared the data of thyroid cancer patients on dialysis (n = 9) with the data of patients who had histopathologically verified benign thyroid disease on dialysis (n = 23) and with the histopathological data of thyroid cancer patients without ESRD. Papillary thyroid cancer (PTC) was the only histotype that was found in 9 of 420 (2.1%) ESRD patients on dialysis. Multifocal PTC was found in eight of nine patients; of them, four had follicular variant of PTC (FVPTC). Two patients had lymphatic metastasis at diagnosis. Eight PTCs were classified as tumor-node-metastasis (TNM) stage I and one as stage II. Among the analyzed factors, age (r = 0.374, p = 0.01) and duration of dialysis (r = 0.436, p = 0.007) showed a significant positive correlation with the occurrence of thyroid cancer. We conclude that the prevalence of thyroid cancer in patients undergoing dialysis was not higher than that in the background population. Age and duration of dialysis showed a significant positive correlation with the occurrence of thyroid cancer in patients on dialysis. Among the histotypes, there may be higher percentage of PTC, FVPTC, and multifocality in dialysis patients. The effect of these characteristics on prognosis of thyroid cancer in dialysis patients is needed to be further evaluated.

Research paper thumbnail of Needle-Free Delivery of Lidocaine for Reducing the Pain Associated with the Fine-Needle Aspiration Biopsy of Thyroid Nodules: Time-Saving and Efficacious Procedure

Thyroid, 2007

Objective: Fine-needle aspiration biopsy (FNAB) is a mandatory procedure in evaluation of thyroid... more Objective: Fine-needle aspiration biopsy (FNAB) is a mandatory procedure in evaluation of thyroid nodules. However, it is sometimes perceived as a painful procedure by the patients. Efficacy of the needle-free injection of local anesthesia for reducing the pain associated with other cutaneous procedures that involve needle insertion was previously reported. In this double-blind, placebo-controlled clinical trial, we evaluated the effectiveness of a needle-free injection of lidocaine in achieving satisfactory pain control in patients undergoing FNAB of thyroid nodules. Design: Patients were allocated to receive either lidocaine administered by needle-free injection system (n ¼ 55) or placebo (isotonic saline) (n ¼ 52) 2-3 minutes before FNAB. A series of four aspirations of each nodule was performed. The patients rated pain associated with the procedure according to a 100-mm visual analog scale (VAS), an 11-point numeric rating scale (NRS), and a four-category verbal rating scale (VRS). Main outcome measure: The two groups studied were similar with respect to age, sex, thyroid volume, nodule size, and nodule site. When the effectiveness of lidocaine was compared with that of placebo, the mean VAS score was 11.4 ± 13.6 mm versus 38.2 ± 35.5 mm (p < 0.0001) and the mean NRS score was 1.4 ± 1.5 points versus 3.9 ± 2.6 points (p < 0.0001), respectively. The absolute numbers according to VRS score in each group was also significantly different (p < 0.0001). The percentage of patients with ''no pain'' or ''mild pain'' in the lidocaine group (90.9%) was significantly higher than that in the placebo group (44.2%) (p < 0.0001). Less than 10% of the patients in lidocaine group experienced moderate pain and none experienced severe pain. No adverse treatment-related effects were observed. Conclusions: To our knowledge, this is the first study demonstrating that the needle-free delivery of lidocaine is an effective, useful, and noninvasive method of providing local anesthesia for the FNAB of thyroid nodules.

Research paper thumbnail of Clinical and Genetic Experience in Turkish Multiple Endocrine Neoplasia Type 2 Families

The Endocrinologist, 2007

Abstract Multiple endocrine neoplasia type 2 (MEN 2) is an inherited disease caused by germline m... more Abstract Multiple endocrine neoplasia type 2 (MEN 2) is an inherited disease caused by germline mutations in the ret proto-oncogene. Identification of the germline mutation is crucial for the diagnosis and management of MEN 2. Fifteen independent families with ...

Research paper thumbnail of Effects of raloxifene on platelet functions in patients with postmenopausal osteoporosis

Platelets, 2006

Many studies have addressed the effects of estrogenic compounds on platelet function. Raloxifene ... more Many studies have addressed the effects of estrogenic compounds on platelet function. Raloxifene is a selective estrogen receptor modulator (SERM), which is currently used for the treatment of postmenopausal osteoporosis. At present, there are no clinical data about the effects of raloxifene on platelet function. The purpose of this study was to determine if raloxifene at therapeutic doses affects platelet function in patients with postmenopausal osteoporosis. The effects of raloxifene on platelet function were investigated using a commercial platelet function analyzer (PFA-100) with collagen epinephrine and collagen adenosine 5&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-diphosphate (ADP) cartridges. We studied platelet function of 30 patients with postmenopausal osteoporosis before and 15 days after initiation of raloxifene 60 mg/daily. Closure times did not differ significantly between samples obtained before (117.8 +/- 20.5 s) and after raloxifene therapy (106.5 +/- 25.4 s) in collagen/epinephrine cartridges (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). There was also no statistically significant difference in mean closure times with collagen/ADP cartridges at baseline (86.2 +/- 18.5 s) and after raloxifene therapy (84.4 +/- 13.8 s) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Platelet counts (278.3 +/- 72.9 vs. 262.4 +/- 56.7 109/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) and mean platelet volumes (8.9 +/- 1 vs. 9.1 +/- 1 fL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) were not different before and after raloxifene therapy. Although estrogen related compounds do affect platelet function, there is suggestive data in our study that raloxifene in therapeutic dose exhibit no effect on platelet function in patients with postmenopausal osteoporosis.

Research paper thumbnail of SSuubbcclliinniiccaall HHyyppootthhyyrrooiiddiissmm iiss nnoott AAssssoocciiaatteedd wwiitthh H Hyyppeerrhhoommooccyysstteeiinnyyeemmiiaa Subklinik Hipotiroidi Hiperhomosisteinemi ile ‹liflkili Deildir

Objective: There are controversial reports regarding subclinical hypothyroidism and its associati... more Objective: There are controversial reports regarding subclinical hypothyroidism and its association with hyperhomocysteinyemia. We aimed to evaluate whether subclinical hypothyroidism is associated with hyperhomocysteinyemia and sought to explain the observed increased risk of coronary artery disease in patients with subclinical hypothyroidism. Materials and Methods: Seventy patients (56 women, 14 men; mean age, 57.0±12.4 years) with subclinical hypothyroidism and 124 euthyroid

Research paper thumbnail of CCoommppaarriissoonn ooff tthhee AAnnaallggeessiicc EEffffiiccaaccyy ooff LLiiddooccaaiinnee//PPrriillooccaaiinnee ((EEMMLLAA)) CCrreeaamm aanndd NNeeeeddllee--FFrreeee DDeelliivveerryy o off LLiiddooccaaiinnee DDu urriinngg F Fiinnee--NNeeeeddllee AAssppiirraattiioonn BBiiooppssyy ooff TThhyyrro...

Objective: Efficacy of eutectic mixture of local anesthetic (EMLA) cream and the needle-free inje... more Objective: Efficacy of eutectic mixture of local anesthetic (EMLA) cream and the needle-free injection of local anesthesia for reducing pain associated with fine-needle aspiration biopsy (FNAB) of thyroid nodules has been previously reported. However, there has not been a direct com- parison of the analgesic efficacy of these methods. The aim of this study was to compare the analgesic efficacy

Research paper thumbnail of Changes in Insulin Sensitivity and Glucose and Bone Metabolism over Time in Patients with Asymptomatic Primary Hyperparathyroidism

Objective: The clinical profile of asymptomatic primary hyperpara- thyroidism (PHPT) has shifted ... more Objective: The clinical profile of asymptomatic primary hyperpara- thyroidism (PHPT) has shifted from a symptomatic disorder toward a more subtle, asymptomatic state. The lack of knowledge about the natural course of asymptomatic PHPT contributes to the controversy regarding the optimal management of these patients. The aim of this study is to evaluate the natural course of calcium and glucose me-

Research paper thumbnail of Fine needle aspiration biopsy of a thyroid nodule: A comparison of diagnostic performance of experienced and inexperienced physicians

Endocrine Practice, 2010

ABSTRACT To determine whether a difference exists in terms of obtaining adequate cytologic sample... more ABSTRACT To determine whether a difference exists in terms of obtaining adequate cytologic samples from ultrasound-guided fine-needle aspiration cytology (US-FNAC) between experienced and inexperienced physicians in a tertiary referral center. In a prospective design, all patients with thyroid nodules of at least 10 mm in diameter were referred for US-FNAC tissue sampling as a part of their diagnostic work-up. Between May 2006 and September 2009, 997 euthyroid patients with 1,320 thyroid nodules were referred for US-FNAC by the attending endocrinologist (experienced physician) or 1 of 2 endocrinology fellows (inexperienced physicians). Of the 1,320 nodules, 713 biopsy specimens were obtained by the experienced physician and 607 were obtained by the inexperienced physicians. Nodule size was significantly larger in the endocrinologist&#39;s group of patients than in the fellows&#39; group of patients (17 mm versus 14 mm, respectively; P&lt;.001). The inadequacy rate of the US-FNAC procedures performed by the experienced physician (22 of 713 thyroid nodules or 3.1%) was significantly lower than for those performed by the inexperienced physicians (102 of 607 thyroid nodules or 16.8%) (P&lt;.001). We conclude that, with increasing operator experience, the number of inadequate cytologic specimens generated by US-FNAC procedures is substantially reduced. This limits both direct and indirect costs and also minimizes the risks of possibly unnecessary surgical procedures.

Research paper thumbnail of Thyroid volume in patients with glucose metabolism disorders

Arquivos brasileiros de endocrinologia e metabologia, 2014

Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistan... more Thyroid volume and the prevalence of thyroid nodules are higher in patients with insulin resistance. A relationship between thyroid volume and glucose metabolism disorders (GMD) has not as yet been clarified. The present retrospective study aimed to investigate the association between GMD and thyroid volume. We investigated the data of 2,630 patients who were evaluated for thyroid biopsy in our hospital. The study population included 602 patients with GMD, 554 patients with diabetes mellitus (DM) and 1,474 patients with normal glucose metabolism as a control group. We obtained the levels of serum thyroid stimulating hormone (TSH) and the thyroid volumes of those patients retrospectively. The median ages for the control group, GMD group and DM group were 55 (15-91) years, 60 (27-97) years, and 65 (27-91) years respectively and there was a statistically significant difference between the groups with regard to age and gender (p<0.001). Levels of TSH were similar in all groups. The m...

Research paper thumbnail of Clinical and epidemiological characteristics of thyroid hemiagenesis: ultrasound screening in patients with thyroid disease and normal population

Endocrine, 2008

Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to dev... more Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to develop. The true prevalence of this rare abnormality is about 0.05-0.2% in normal population. We aimed to determine prevalence of thyroid hemiagenesis in patients with various thyroid disorders and a normal population in a mild to moderate iodine-deficient area. The clinical and thyroid ultrasonography records of 4,833 patients who presented with various thyroid disorders were reviewed. In addition, ultrasonographic data of two large surveys carried out for the community screening of iodine status of children (n = 4,772) and thyroid disorders of adult subjects (n = 2,935) were analyzed. In patients with thyroid disorders, we found 12 cases with thyroid hemiagenesis (0.25%). Thyroid hemiagenesis was due to the agenesis of the left lobe in all cases. The underlying thyroid diseases were Hashimoto's thyroiditis (n = 4), euthyroid multinodular goiter (n = 4), and toxic adenoma (n = 1). Thr...

Research paper thumbnail of Isolated office hypertension: association with target organ damage and cardiovascular risk indices

Journal of the National Medical Association, 2006

Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, w... more Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, whereas others believe that it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this present study was to evaluate the effects of IOH on target organ damage and cardiovascular risk indices. Arterial blood pressure (BP) measured in the office and by 24-hour ambulatory blood pressure measurement (ABMP), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), cardiothoracic index (CTI), duration of QTc, 24-hour microalbuminuria, fibrinogen, C-reactive protein (CRP), total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels were evaluated. Thirty-three subjects with IOH (office BP > or = 140/90 mmHg and daytime ambulatory BP <135/85 mmHg), 17 patients with sustained hypertension (office BP > or = 140/90 mmHg and daytime ambulatory BP > or = 135/85 ...

Research paper thumbnail of Effect of sibutramine on blood pressure in patients with obesity and well-controlled hypertension or normotension

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

To assess the short-term effects of sibu-tramine on blood pressure (BP) and heart rate (HR) in no... more To assess the short-term effects of sibu-tramine on blood pressure (BP) and heart rate (HR) in normotensive and controlled hypertensive obese patients by using ambulatory blood pressure monitoring (ABPM). Before and 5 to 7 days after the initiation of sibutramine treatment (10 mg or 15 mg daily), when steady-state concentrations of sibutramine had been reached, ABPM was performed in 81 obese patients. Of this overall study group, 47 patients (26 with normoten-sion and 21 with controlled hypertension) received sibu-tramine in a dosage of 10 mg/day, and 34 patients (18 with normotension and 16 with controlled hypertension) received sibutramine in a dosage of 15 mg/day. Office-measured systolic and diastolic BPs in normotensive and controlled hypertensive groups of patients with obesity were not significantly different before and after treatment with both doses of sibutramine. ABPM results for normotensive obese groups showed that mean systolic and diastolic BPs were not significantly ...

Research paper thumbnail of Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle (Urtica dioica )

Nettle (Urtica dioica ) is commonly sold as a herbal tea in Turkey. We report a case of gynaecoma... more Nettle (Urtica dioica ) is commonly sold as a herbal tea in Turkey. We report a case of gynaecomastia in a man (in which the only aetiologic factor identified was nettle tea consumption) and a case of galactorrhoea in a woman (in which the only aetiologic factor identified was also nettle tea ingestion). The term gynaecomastia describes the enlargement of

Research paper thumbnail of New-Onset Acute Heart Failure After Intravenous Glucocorticoid Pulse Therapy in a Patient with Graves' Ophthalmopathy

Endocrine, 2006

A 53-yr-old previously healthy man was admitted to our hospital for thyrotoxicosis without ophtha... more A 53-yr-old previously healthy man was admitted to our hospital for thyrotoxicosis without ophthalmopathy. Initial therapy with propylthiouracil caused an acute elevation of liver enzymes. Then, he received a first course of 131I therapy (20 mCi). At the end of 6-mo follow-up after 131I, he was still thyrotoxic and developed moderately severe ophthalmopathy. The patient refused thyroid surgery and decided to undergo second course of 131I therapy (30 mCi). Concomitantly with the 131I, we opted to give high-dose pulse glucocorticoid therapy (PGT) to prevent further deterioration of GO. The patient was started on intravenous methylprednisolone pulse therapy 1 g daily in a cycle (one cycle every 2 wk, each cycle comprising two infusions on alternate days). After the end of the second day of PGT administration, he suddenly developed onset of acute pulmonary edema and hypertension. There was no previous history of cardiac disorder or conditions predisposing to cardiac failure other than thyrotoxicosis. A presumptive diagnosis of fluid overload and/or hypertension- induced acute heart failure was made. After prompt investigations excluding cardiogenic causes, we thought that this condition was triggered by PGT that was superimposed on thyrotoxicosis-related hemodynamic instability. Graves&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; patients with uncontrolled thyrotoxicosis should be under careful surveillance when PGT is planned. To our knowledge, this is the first reported case of life-threatening acute pulmonary edema caused by PGT in GO.

Research paper thumbnail of Postprandial Lipemia as a Risk Factor for Cardiovascular Disease in Patients with Hypothyroidism

Endocrine, 2006

Postprandial lipoprotein metabolism is suggested to play a role in the pathogenesis of atheroscle... more Postprandial lipoprotein metabolism is suggested to play a role in the pathogenesis of atherosclerosis. In this study, we investigated postprandial lipemia and its relationship to cardiovascular risk factors in patients with overt and subclinical hypothyroidism. Twenty-nine female patients with TSH levels greater than 5 microIU/mL and 12 euthyroid control female subjects were included in the study. Fifteen patients had subclinical hypothyroidism and 14 had overt hypothyroidism. All subjects underwent an oral lipid tolerance test. If triglyceride levels increased by 80% or more, subjects were considered postprandial lipemia positive. Control, overt hypothyroid, and subclinical hypothyroid groups were not statistically different with respect to anthropometric measurements, fasting blood C-reactive protein, uric acid, homocysteine, glucose, insulin, lipoprotein (a), apolipoprotein B levels, and homeostasis model assessment index. Fasting triglyceride levels correlated positively with TSH levels. Postprandial lipemia frequency was higher in overt hypothyroid subjects than in the control group. The subclinical hypothyroid group did not differ from the hypothyroid group with respect to postprandial lipemia frequency. In subjects with TSH levels higher than 5 microIU/mL, PPL risk was increased sevenfold. The results of this study show that postprandial triglyceride metabolism is affected in hypothyroidism.

Research paper thumbnail of Hashimoto's Thyroiditis Is Not Associated with Increased Risk of Thyroid Cancer in Patients with Thyroid Nodules: A Single-Center Prospective Study

Thyroid, 2010

The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto&amp;... more The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto&amp;amp;amp;amp;#39;s thyroiditis (HT) is a debatable issue. The studies defining the true risk of thyroid malignancy are scanty and mainly depend on retrospective series. To eliminate inherent bias of retrospective studies, this prospective study was carried out to evaluate the true malignancy rate of unselected thyroid nodules in patients with HT who underwent fine-needle aspiration cytology (FNAC). These prospective data were gathered on all patients newly diagnosed with thyroid nodules who were sent for FNAC between May 2006 and August 2009. All patients were evaluated for the presence of HT diagnosis by measuring thyroid autoantibodies. If a patient had at least one positive thyroid autoantibody, then the patient was defined as HT with thyroid nodules. There were 164 patients (147 women and 17 men) with thyroid nodules associated with HT (HT group). There were 551 patients (432 women and 119 men) with thyroid nodules without HT (control group). All patients underwent FNAC and ultrasonography (US). The malignancy rate was 1.0% in HT group (2 out of 191 nodules) and 2.7% in the control group (19 out of 713 nodules), a not significant (p = 0.19) difference. In the two cytologically malignant nodules in HT group and 19 in the control group, papillary thyroid carcinoma was diagnosed after thyroidectomy and histopathological examination. US features of nodule echogenicity, structure, margin, and Doppler flow were similar between the two groups. US features of microcalcification and absence of peripheral halo were more prominent in the nodules of the control group (p = 0.002 and p &amp;amp;amp;amp;lt; 0.001, respectively). On the basis of cytopathological criteria, thyroid nodules in patients with HT are no more likely to be malignant than in those without HT. Many of the US features of benign thyroid nodules are similar in patients with and patients without HT.

Research paper thumbnail of Subclinical Cushing Syndrome Presenting With Hypertension and Hypokalemia

The Endocrinologist, 2007

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Th... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Endocrinologist. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is ...

Research paper thumbnail of Rosiglitazone Decreases Serum Bone-Specific Alkaline Phosphatase Activity in Postmenopausal Diabetic Women

Results: Serum total alkaline phosphatase (ALP) and bone-specific ALP levels were statistically s... more Results: Serum total alkaline phosphatase (ALP) and bone-specific ALP levels were statistically significantly lower 12 wk after initiation of rosiglitazone treatment. There were no statistically significant changes in osteocalcin levels among the three groups or in deoxypyr- idinoline levels in the rosiglitazone group. At the end of 12 wk, all patients had statistically significantly decreased IL-1 and TNF- levels compared

Research paper thumbnail of Mean platelet volume in patients with polycystic ovary disease

Platelets, 2006

1. Platelets. 2006 Nov;17(7):505-6. Mean platelet volume in patients with polycystic ovary diseas... more 1. Platelets. 2006 Nov;17(7):505-6. Mean platelet volume in patients with polycystic ovary disease. Gursoy A, Ertugrul DT, Pamuk B, Sahin M, Asik M, Yilmaz H, Haydardedeoglu F, Tutuncu NB, Demirag NG. PMID: 17074730 [PubMed - indexed for MEDLINE]. ...

Research paper thumbnail of Comparison of Palpation-Guided Fine-Needle Aspiration Biopsy to Ultrasound-Guided Fine-Needle Aspiration Biopsy in the Evaluation of Thyroid Nodules

Thyroid, 2006

Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method,... more Although fine-needle aspiration biopsy (FNAB) of thyroid nodules is a reliable and simple method, the diagnostic value may be limited by inadequate and false-negative results. In this prospective study, we compared palpation-guided FNAB (PGFNAB) with ultrasound-guided FNAB (UGFNAB) to establish the rates of inadequate material and cost-effectiveness. A total of 285 thyroid nodules in 215 patients were included in the study. Palpable nodules with the greatest diameter between 1 and 2.5 cm were included in the study. PGFNAB and UGFNAB techniques were applied to the same nodule by the same operator. Cytologic evaluations were performed by the same cytologist in a blinded fashion. To provide cost analysis, the prices obtained from different hospitals were evaluated. The rates of inadequate material for PGFNAB and UGFNAB were significantly different as 32.3% and 21.4%, respectively (p = 0.004). There was significantly higher inadequate material rate in PGFNAB group for small-sized nodules (greatest nodule diameter between 10 and 15 mm) (p = 0.009), despite inadequate material rate was not significant for both procedures for larger sized nodules. False-negative results were 15.8% for PGFNAB and 5.6% for UGFNAB. Regarding cost analysis, the difference between the two methods was 20 dollars on average for each patient. We consider UGFNAB to be superior to PGFNAB for obtaining adequate material especially for small-sized nodules, as well as providing more accurate cytologic evaluation. Indeed, the difference between the costs of two procedures might be acceptable.

Research paper thumbnail of Clinicopathological Characteristics of Thyroid Cancer in Patients on Dialysis for End-Stage Renal Disease

Thyroid, 2008

The prevalence rate of thyroid cancers in patients with renal failure is variable in different st... more The prevalence rate of thyroid cancers in patients with renal failure is variable in different studies. Our aim was to determine the prevalence and clinicopathological characteristics of thyroid cancers in the dialysis population and to evaluate the potential risk factors. We performed a retrospective analysis on end-stage renal disease (ESRD) patients on dialysis and thyroidectomized patients without ESRD (2000-2006). Then we compared the data of thyroid cancer patients on dialysis (n = 9) with the data of patients who had histopathologically verified benign thyroid disease on dialysis (n = 23) and with the histopathological data of thyroid cancer patients without ESRD. Papillary thyroid cancer (PTC) was the only histotype that was found in 9 of 420 (2.1%) ESRD patients on dialysis. Multifocal PTC was found in eight of nine patients; of them, four had follicular variant of PTC (FVPTC). Two patients had lymphatic metastasis at diagnosis. Eight PTCs were classified as tumor-node-metastasis (TNM) stage I and one as stage II. Among the analyzed factors, age (r = 0.374, p = 0.01) and duration of dialysis (r = 0.436, p = 0.007) showed a significant positive correlation with the occurrence of thyroid cancer. We conclude that the prevalence of thyroid cancer in patients undergoing dialysis was not higher than that in the background population. Age and duration of dialysis showed a significant positive correlation with the occurrence of thyroid cancer in patients on dialysis. Among the histotypes, there may be higher percentage of PTC, FVPTC, and multifocality in dialysis patients. The effect of these characteristics on prognosis of thyroid cancer in dialysis patients is needed to be further evaluated.

Research paper thumbnail of Needle-Free Delivery of Lidocaine for Reducing the Pain Associated with the Fine-Needle Aspiration Biopsy of Thyroid Nodules: Time-Saving and Efficacious Procedure

Thyroid, 2007

Objective: Fine-needle aspiration biopsy (FNAB) is a mandatory procedure in evaluation of thyroid... more Objective: Fine-needle aspiration biopsy (FNAB) is a mandatory procedure in evaluation of thyroid nodules. However, it is sometimes perceived as a painful procedure by the patients. Efficacy of the needle-free injection of local anesthesia for reducing the pain associated with other cutaneous procedures that involve needle insertion was previously reported. In this double-blind, placebo-controlled clinical trial, we evaluated the effectiveness of a needle-free injection of lidocaine in achieving satisfactory pain control in patients undergoing FNAB of thyroid nodules. Design: Patients were allocated to receive either lidocaine administered by needle-free injection system (n ¼ 55) or placebo (isotonic saline) (n ¼ 52) 2-3 minutes before FNAB. A series of four aspirations of each nodule was performed. The patients rated pain associated with the procedure according to a 100-mm visual analog scale (VAS), an 11-point numeric rating scale (NRS), and a four-category verbal rating scale (VRS). Main outcome measure: The two groups studied were similar with respect to age, sex, thyroid volume, nodule size, and nodule site. When the effectiveness of lidocaine was compared with that of placebo, the mean VAS score was 11.4 ± 13.6 mm versus 38.2 ± 35.5 mm (p < 0.0001) and the mean NRS score was 1.4 ± 1.5 points versus 3.9 ± 2.6 points (p < 0.0001), respectively. The absolute numbers according to VRS score in each group was also significantly different (p < 0.0001). The percentage of patients with ''no pain'' or ''mild pain'' in the lidocaine group (90.9%) was significantly higher than that in the placebo group (44.2%) (p < 0.0001). Less than 10% of the patients in lidocaine group experienced moderate pain and none experienced severe pain. No adverse treatment-related effects were observed. Conclusions: To our knowledge, this is the first study demonstrating that the needle-free delivery of lidocaine is an effective, useful, and noninvasive method of providing local anesthesia for the FNAB of thyroid nodules.

Research paper thumbnail of Clinical and Genetic Experience in Turkish Multiple Endocrine Neoplasia Type 2 Families

The Endocrinologist, 2007

Abstract Multiple endocrine neoplasia type 2 (MEN 2) is an inherited disease caused by germline m... more Abstract Multiple endocrine neoplasia type 2 (MEN 2) is an inherited disease caused by germline mutations in the ret proto-oncogene. Identification of the germline mutation is crucial for the diagnosis and management of MEN 2. Fifteen independent families with ...

Research paper thumbnail of Effects of raloxifene on platelet functions in patients with postmenopausal osteoporosis

Platelets, 2006

Many studies have addressed the effects of estrogenic compounds on platelet function. Raloxifene ... more Many studies have addressed the effects of estrogenic compounds on platelet function. Raloxifene is a selective estrogen receptor modulator (SERM), which is currently used for the treatment of postmenopausal osteoporosis. At present, there are no clinical data about the effects of raloxifene on platelet function. The purpose of this study was to determine if raloxifene at therapeutic doses affects platelet function in patients with postmenopausal osteoporosis. The effects of raloxifene on platelet function were investigated using a commercial platelet function analyzer (PFA-100) with collagen epinephrine and collagen adenosine 5&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-diphosphate (ADP) cartridges. We studied platelet function of 30 patients with postmenopausal osteoporosis before and 15 days after initiation of raloxifene 60 mg/daily. Closure times did not differ significantly between samples obtained before (117.8 +/- 20.5 s) and after raloxifene therapy (106.5 +/- 25.4 s) in collagen/epinephrine cartridges (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). There was also no statistically significant difference in mean closure times with collagen/ADP cartridges at baseline (86.2 +/- 18.5 s) and after raloxifene therapy (84.4 +/- 13.8 s) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Platelet counts (278.3 +/- 72.9 vs. 262.4 +/- 56.7 109/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) and mean platelet volumes (8.9 +/- 1 vs. 9.1 +/- 1 fL, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) were not different before and after raloxifene therapy. Although estrogen related compounds do affect platelet function, there is suggestive data in our study that raloxifene in therapeutic dose exhibit no effect on platelet function in patients with postmenopausal osteoporosis.